The Case of Sore Tongue and Cracked Lip Corners

Angular cheilitis in a 65-year-old female

I saw a 65-year-old female the other day with a complaint of soreness in mouth. The soreness had been present for 2 years and it was especially difficult for her to consume spicy and acidic foods. Tongue and corners of the lips were particularly more painful. The patient had seen several doctors, had been prescribed topical steroids, antivirals and antibiotics. The topical steroids seemed to help initially but then the pain started getting worse. 

The patient was on medication for diabetes and hypertension. She was also taking antibiotics for her urinary tract infection quite frequently. 

Extra-oral exam revealed redness at the corners of the mouth. Papillary atrophy was noted on the tongue. Because of pain at lip commissures, the patient was unable to open mouth completely for intra-oral photographs.

The candida culture was positive. The patient was given a course of antifungals, Clotrimazole troches in this case. She was told to dissolve the tablet slowly in mouth and ensure that she licks the corners of the lips (to heal angular cheilitis). Fifty troches were to be used over 10 days.

Vytone, which is blend of iodquinol and corticosteroid can be prescribed separately to treat angular cheilitis. This product can only be used externally.

The patient was also told that diabetes and frequent use of antibiotics have predisposed her to candidiasis. The organism will reappear  at some point and we will just have to retreat it (topical antifungals do not have systemic effects and repetitive usage is not harmful).

Three days later the patient called to say that she was pain-free. She did return for follow-up 10 days later, the redness at the corner of the lips was healed and the papilla on the tongue was regenerating. 

For a detailed discussion on candidiasis, please see The Case of Central Papillary Atrophy.